Continuous Support & Fees – A Guide for Doulas
One of the key components of all studies that support doula care is the continuous presence of the labour support professional. That means the doula is there for the entire labour, whether it is four hours or twenty four hours. This is the job we sign on for. If for some reason, we cannot fulfill the hourly obligation, then we have the option to call in a back up doula to maintain continuous presence.
Some doulas are learning that this model is not viable from a financial perspective yet we have to realize that this is the type of care that was repeatedly researched and found most beneficial in the reduction of interventions.
There have been a great many discussions and lively debates about leaving a woman with an epidural, going home to get some rest, and returning when the client is in further need of our services. The problem is that a woman with an epidural often has the need for emotional support, side effects from the epidural, does not sleep soundly or for long and sometimes things change ridiculously quickly after the epidural is administered and not always in a way that is anticipated. Some doulas are also discussing their departure during unplanned cesareans and the return hours later, or even a day later, for postpartum support but again, without a magic crystal ball, you can’t foresee what type of care will be needed for the mother or her partner. The key in the research to providing positive outcomes is continuous emotional and physical support and on occasion, this will mean sitting in a hallway alone.
Utilizing language that stipulates a timeline for supportive presence is dangerous for some parents and perfectly understandable and legitimate to others; you must know your audience and be able to adapt. As a doula, you can not predict outcomes or needs based on those same outcomes. In addition, in 2015 The Doula Group in Ontario Canada reports an overall epidural rate of approximately 34%, a cesarean rate of 12% and the births that were more than 12 hours were only 11%. A whopping 20% were in four hours or less. Doulas do not refund for those very short labours, and thus we do not charge extra for those that go longer but that is only the policy of this particular group. As an independent contractor, you get to decide how you want to be paid, but understand this: the benefited outcomes of a doula’s service is based upon continuous presence.
This five part series on setting fees is an aide for the new doula to understand all that goes into setting a reasonable fee that you feel is the best for that particular doula.